NPIMap

Organization Active NPI

CS Medical Associates, P.C.

Doing business as Victory Recovery Partners

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Hicksville, NY
National Provider Identifier
1194432815
Registry record updated Nov 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
CS MEDICAL ASSOCIATES, P.C.
Doing business as
Victory Recovery Partners
Practice address
120 Bethpage Rd Ste 101
Hicksville, NY 11801-1515
Phone
(631) 696-4357
NPI assigned
Nov 2, 2022
Last updated
Nov 2, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
CS MEDICAL ASSOCIATES, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 2, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tracey Wallace
Title
VP Operations
Phone
(631) 696-4357

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU Primary
Addiction Medicine (Preventive Medicine) Physician 2083A0300X NU

Addresses

Primary practice location

120 Bethpage Rd Ste 101
Hicksville, NY 11801-1515

Mailing address

100 Granny Rd
Farmingville, NY 11738-2879
Phone (631) 696-4357

Other identifiers 1

IdentifierTypeStateIssuer
05150629MedicaidNY

Other names 1

  • Victory Recovery Partners Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2271490CS Medical Associates PC120 Bethpage Rd - Suite 1, Hicksville, NY 11801Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
CS Medical Associates PC8 organizations share this tax ID, including this one
Part of
CS Medical Associates PC

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

100 Granny Rd
Farmingville, NY 11738
Phone (631) 698-7828

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1667347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667347200000",
    "number": "1194432815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 GRANNY RD",
            "city": "FARMINGVILLE",
            "state": "NY",
            "postal_code": "117382879",
            "telephone_number": "631-696-4357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 BETHPAGE RD STE 101",
            "city": "HICKSVILLE",
            "state": "NY",
            "postal_code": "118011515",
            "telephone_number": "631-696-4357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CS MEDICAL ASSOCIATES, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CS MEDICAL ASSOCIATES, P.C.",
        "enumeration_date": "2022-11-02",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_title_or_position": "VP OPERATIONS",
        "authorized_official_telephone_number": "631-696-4357"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2083A0300X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05150629",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Victory Recovery Partners",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hicksville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.